RT Journal Article
SR Electronic
T1 A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP 315
OP 321
DO 10.1136/bmjspcare-2011-000054
VO 1
IS 3
A1 Sue Hall
A1 Cassie Goddard
A1 Diana Opio
A1 Peter W Speck
A1 Pauline Martin
A1 Irene J Higginson
YR 2011
UL http://spcare.bmj.com/content/1/3/315.abstract
AB Main objective To assess the ability of dignity therapy to reduce distress in advanced cancer patients. Design A phase II open-label trial. Setting Two UK National Health Service trusts. Participants 45 adults with advanced cancer. Intervention Dignity therapy: a brief palliative care psychotherapy. Methods Participants were randomly allocated to receive the intervention plus standard care or standard care only (control group). Outcomes were collected at baseline and at 1- and 4-week follow-up. Main outcome measures The primary outcome was dignity-related distress (Palliative Dignity Inventory). Secondary outcomes were hope, anxiety and depression, quality of life, palliative-related outcomes, and self-reported study benefits. Results 45/188 (24%) patients responded. 27/45 (60%) participants remained at 1-week and 20/45 (44%) at 4-week follow-up. Baseline levels of distress were low. Groups did not differ in dignity-related distress at any time. An effect on only one secondary outcome was found: the intervention group reported more hope than the control group at both follow-ups. Effect sizes were medium (partial η2=0.20 and 0.15) and the difference was statistically significant at 1-week follow-up (difference in adjusted means 2.55; 95% CI −4.73 to 0.36; p=0.02). The intervention group was more positive than the control group on all the self-reported benefits ratings. Effect sizes (Cohen's d) ranged from 1.34 for feeling that dignity therapy had helped to 0.31 for increasing will to live. Conclusions The effects of dignity therapy on people with advanced cancer are encouraging. Further investigation is warranted focusing on distressed patients and those earlier in the palliative care trajectory. Trial register number ISRCTN29868352.